Implantable cardioverter-defibrillators (ICDs) have been shown to reduce mortality as primary1 and secondary prevention2,3 of sudden death from ventricular tachycardia or ventricular fibrillation in selected patients. However, defibrillator shocks, whether for appropriate or inappropriate indications, are associated with adverse effects. These adverse effects include the acute discomfort of the shock as well as late and longer-lasting psychological trauma including depression and posttraumatic stress disorder.4 In addition to the psychological effects of shocks, there is a clear and somewhat paradoxical association between ICD shocks and increased mortality. In the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) and in the Sudden Cardiac Death in Heart Failure Trial, ICD shocks were associated with a 2- to 5-fold increased risk of death.5,6 There has been a long-standing debate as to whether this increased mortality is a direct result of shocks having adverse effects on myocardial function leading to worsening congestive heart failure and death or whether the arrhythmias that lead to ICD shocks are markers of deteriorating myocardial function that leads to death.7- 9 Only by performing a clinical trial that randomizes patients to strategies that lead to different risks of ICD shock after receiving an implant could this important question be answered.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.